| Lake County Tribal Health Consortium Inc. | |
|
925 Bevins Ct Lakeport CA 95453-9754 | |
| (707) 263-8382 | |
| (707) 263-0329 |
| Full Name | Lake County Tribal Health Consortium Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 925 Bevins Ct, Lakeport, California |
| Authorized Official Name and Position | Ernesto Padilla (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7072638382 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake County Tribal Health Consortium Inc. 925 Bevins Ct Lakeport CA 95453-9754 Ph: (707) 263-8382 | Lake County Tribal Health Consortium Inc. 925 Bevins Ct Lakeport CA 95453-9754 Ph: (707) 263-8382 |
| NPI Number | 1881697381 |
|---|---|
| Provider Enumeration Date | 05/27/2005 |
| Last Update Date | 11/16/2011 |
| Medicare PECOS PAC ID | 8729975545 |
|---|---|
| Medicare Enrollment ID | O20040304000323 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881697381 | NPI | - | NPPES |
| THP70611F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 110000289 (California) | Primary |
| Provider Name | Terri L Turner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366522831 PECOS PAC ID: 9830188671 Enrollment ID: I20040507000904 |
| Provider Name | Francisco Tejeda |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1407940075 PECOS PAC ID: 1759343080 Enrollment ID: I20041029000420 |
| Provider Name | Andre P Lallande |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053471045 PECOS PAC ID: 4385680545 Enrollment ID: I20050628001395 |
| Provider Name | Javier Arroyo |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1821183732 PECOS PAC ID: 0941226252 Enrollment ID: I20051017000425 |
| Provider Name | Joan Devito |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1962549469 PECOS PAC ID: 5597803973 Enrollment ID: I20091104000406 |
| Provider Name | Diane E Bajada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932354321 PECOS PAC ID: 7810032141 Enrollment ID: I20100310000947 |
| Provider Name | Derrick J Barnes |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1336236488 PECOS PAC ID: 5294802872 Enrollment ID: I20150717002250 |
| Provider Name | Angelo J Chavez Guerrero |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235465774 PECOS PAC ID: 9537296132 Enrollment ID: I20160225001197 |
| Provider Name | Hamayun Nawaz |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871817189 PECOS PAC ID: 4082868310 Enrollment ID: I20160304001809 |
| Provider Name | Louise Loe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669924171 PECOS PAC ID: 2163780305 Enrollment ID: I20171218001953 |
| Provider Name | Gemalli Austin |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1407283419 PECOS PAC ID: 0648513440 Enrollment ID: I20190518000101 |
| Provider Name | Gladys Muir |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1710054168 PECOS PAC ID: 7618205451 Enrollment ID: I20190819000805 |
| Provider Name | Charissa M Barsos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215309398 PECOS PAC ID: 4880996875 Enrollment ID: I20191008000526 |
| Provider Name | Shaye Larie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013478569 PECOS PAC ID: 6608102009 Enrollment ID: I20200504000804 |
| Provider Name | Dawn Marie Pavli |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1649896549 PECOS PAC ID: 9830512680 Enrollment ID: I20200713000561 |
| Provider Name | Stephenie L Hargrove |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053927608 PECOS PAC ID: 6305244369 Enrollment ID: I20211006001829 |
| Provider Name | Melissa Flores |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376925271 PECOS PAC ID: 1254707607 Enrollment ID: I20221026001816 |
Upper Lake Clinic Rhc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5176 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-5001 Fax: 707-262-5006 | |
Sutter Lakeside Hospital Mobile Health Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5176 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-5000 Fax: 707-262-5005 | |
Northern California Medical Assoc Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 55 1st St, Ste 210, Lakeport, CA 95453 Phone: 707-462-1516 Fax: 707-462-1178 | |
Adventist Health Physicians Network Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 801 11th St, Lakeport, CA 95453 Phone: 707-263-3746 | |
Tribal Health Pediatrics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 359 Lakeport Blvd, Lakeport, CA 95453 Phone: 707-533-2700 Fax: 707-263-5400 | |
Northern California Medical Assoc Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5108 Hill Rd E, Lakeport, CA 95453 Phone: 707-262-1840 Fax: 707-262-5844 | |
Sutter Bay Hospitals Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5196 Hill Rd E, Suite 300, Lakeport, CA 95453 Phone: 707-263-6885 Fax: 707-263-6624 |